You could sue a health insurance company for negligence in Maryland if you suffered damages or losses due to the denied claim payments. These losses can be a financial injury or more serious health problems. It seems simple, but suing an insurance company can lead to a complicated legal battle. Here, the Baltimore medical malpractice lawyers at Bennett and Heyman explain the legal issues that arise when a health insurance company denies coverage due to negligence as well as other possible claims for breach of contract, “bad faith,” and intentional infliction of emotional distress.
Ambivalent health insurance companies should decide no one’s health. You are entitled to compensation if a denied health insurance claim turned into a more serious medical condition or deep debts and financial losses. Keep reading to learn more.
Maryland Laws Against Negligent Health Insurance Claim Denials
Under Maryland law, certain health insurance claim decisions create a duty or obligation independent of the duties arising out of the contract itself. The duty is imposed by law based on facts recognized under Maryland’s common law. If you are entitled to receive a life-saving medical service, your insurance company has a duty to act in good faith when reviewing your claim.
Negligence is an area of tort law that has three basic legal elements: duty, breach of duty, and harm or damages. In a negligence claim, the duty of care for wrongful denial of a claim arises from the wrongful failure to cover a necessary medical need. Your Baltimore, Maryland personal injury lawyer can explain how these elements apply to your situation at greater length.
Breach of Contract in Bad Faith Insurance Claims
Maryland law recognizes as a tort a breach of contract found to be in “bad faith.” While most of the cases of this nature involve a bad-faith refusal to settle or pay life insurance policies, the situations are analogous when a health insurance company acts in bad faith and causes losses for an insured person. A qualified attorney can evaluate your case and determine whether the actions of the company meet the required legal standard.
Fighting Necessary Medical Treatment Denials in Maryland
Health insurance companies have acquired the ability to question and deny medical expenses by basing their decisions on weak legal and medical arguments. Health insurance companies now hire medical teams to come up with any excuse to deny payment on a claim.
For patients, this is a most disconcerting situation. When insurance companies take on the position that they “know better” than your doctors, they are also potentially taking on the legal responsibility for the losses you suffer. You are entitled to seek accountability if you were denied payment on claims that resulted in further health problems and exacerbated the pace of deterioration of a medical condition.
Can You Sue for “Experimental” Medical Treatment Denials?
The claim that a treatment is experimental is a common reason for denying health insurance payment. Insurance companies use this reason in ways that can be considered negligent — especially in the face of losses experienced.
For example, there are many cancer treatments considered safer and more effective than traditional treatments recognized by the medical community. Many of these treatments are very expensive, and people seek financial support through friends and families online. There are certain instances where an insurance company’s actions in denying coverage for a treatment that may not be fully accepted by the medical community are negligent, especially if it fits the medical needs of a particular patient’s condition better than other treatments.
Pursuing a Negligent Misrepresentation Lawsuit
Every health insurance contract is different. Your health insurance may provide some legal terminology indicating what they promise to service, and you rely on these offerings. In essence, they invite reliance in that they will service your medical needs. Your reliance is the key to establishing a duty of care. Denial of health insurance claims for invalid excuses or co-pays that create a financial burden you didn’t expect could indicate a valid claim of negligent misrepresentation. In a successful negligent misrepresentation lawsuit under Maryland law, you are required to establish:
- The health insurance company negligently asserts a false statement while also owing you a duty of care
- The health insurance company made statements you acted upon
- The health insurance company knows you will probably rely on the statement, which, if erroneous, will cause wrongful death or injury
- You, justifiably, acted in reliance on the statement
- You suffered damage caused by the defendant’s negligence.
Your attorney is best prepared to help you review what was promised versus what you received. Also, your interests are best served when an attorney reviews the extent of your losses to determine what actions you can pursue. Call the office of the Bennett & Heyman to learn more about how we can assist and support you in fighting for your legal rights.
Maryland Lawyers for Insurance Company Negligence Offering Free Consultations
When you are denied a health insurance claim, you are generally required to file a claim with the Maryland Insurance Administration before filing a civil lawsuit. If your claim is denied again and you have medical and financial losses, you shouldn’t hesitate to talk to an experienced Baltimore personal injury attorney. At the Bennett & Heyman Law, we work with multiple medical experts who assist us in our cases and can help us determine if you can pursue legal actions. To learn more about how we can help, ask to meet with one of our attorneys by calling us today at (410) 429-7856.